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  #1  
Old 05-27-2012
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GIT Achalasia, next step

if we have a typical pic of Achalasia
-best initial is Barium (we all agree),
-most accurate is Mano (we all agree)

but what is the best next step after a barium study. is it EGD or Mano
i will go with EGD to rule out malignancy at the EG junction which give pseudoachalasia

correct me if i'm wrong
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  #2  
Old 05-27-2012
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other question, if a pt (in general, not achalasia) present with heartburn and dysphagia for solid, the best initial test will be Endo Vs. Barium
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Old 05-27-2012
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Quote:
Originally Posted by bisho View Post
other question, if a pt (in general, not achalasia) present with heartburn and dysphagia for solid, the best initial test will be Endo Vs. Barium
i guess barium.. unless u hv a clear indication for endoscopy like weight loss/bleeding/anemia/odynophagia etc
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Old 05-27-2012
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Quote:
Originally Posted by bisho View Post
but what is the best next step after a barium study. is it EGD or Mano
i will go with EGD to rule out malignancy at the EG junction which give pseudoachalasia

correct me if i'm wrong
i think it'd be EGD depending on the duration.
if you have a duration long enough 5+ years to warrant ?cancer then youd do it.
OR if you have other risk factors given for malignancy of EG junction

otherwise it'd be manometry to confirm.


regardless while doing Rx with pneumatic dilation endoscopy will be done.
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Old 05-27-2012
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Quote:
Originally Posted by mbbs2010 View Post
i think it'd be EGD depending on the duration.
if you have a duration long enough 5+ years to warrant ?cancer then youd do it.
OR if you have other risk factors given for malignancy of EG junction

otherwise it'd be manometry to confirm.


regardless while doing Rx with pneumatic dilation endoscopy will be done.
isn't that applied to GERD (heartburn) rather than dysphagia
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Old 05-27-2012
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Quote:
Originally Posted by bisho View Post
isn't that applied to GERD (heartburn) rather than dysphagia
sorry
my bad..
your correct...
endoscopy wud be next
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Old 05-27-2012
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Quote:
Originally Posted by bisho View Post
if we have a typical pic of Achalasia
-best initial is Barium (we all agree),
-most accurate is Mano (we all agree)

but what is the best next step after a barium study. is it EGD or Mano
i will go with EGD to rule out malignancy at the EG junction which give pseudoachalasia

correct me if i'm wrong
Depends on the HPE and the finding of Ba
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Old 05-27-2012
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Uworld
Esophageal cancer may mimic achalasia clinically, radiologically AND manometricaly (pseudoachalasia):
Features that favor malignancy over achalasia are:
older age, a short history, rapid weight lOSS, and inability
of the esophagascope to pass through the lower esophageal sphincter.
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Old 05-28-2012
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Quote:
Originally Posted by mbbs2010 View Post
regardless while doing Rx with pneumatic dilation endoscopy will be done.
I agree - interventional endoscopy to both biopsy the junction and dilate the restriction...
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